title: Mental Health Burden Among Impoverished HIV-Positive Patients in Peru.
abstract: HIV and poor mental health are intricately related. In settings of poverty, both are often rooted in structural factors related to material and social deprivation. We performed a qualitative analysis to understand factors contributing to poor emotional health and its impact among impoverished Peruvian HIV-infected individuals. We conducted focus group discussions with patients and providers consisting of semistructured, open-ended questions. Qualitative analysis provided insight into the profound impact of depression, isolation, stigma, and lack of social support among these patients. Living with HIV contributed significantly to mental health problems experienced by HIV-positive individuals; furthermore, long-standing stressors-such as economic hardship, fragmented family relationships, and substance use-shaped patients' outlooks, and may have contributed not only to current emotional hardship but to risk factors for contracting HIV as well. Once diagnosed with HIV/AIDS, many patients experienced hopelessness, stigma, and socioeconomic marginalization. Patients tended to rely on informal sources of support, including peers and community health workers, and rarely used formal mental health services. In resource-poor settings, the context of mental health problems among HIV-positive individuals must be framed within the larger structural context of poverty and social exclusion. Optimal strategies to address the mental health problems of these individuals should include integrating mental health services into HIV care, task shifting to utilize community health workers where human resources are scarce, and interventions aimed at poverty alleviation.
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA, Socios En Salud Sucursal Perú, Lima, Peru, Harvard Medical School, Boston, MA, USA, Division of Infectious Diseases, Brigham and Women's Hospital, Boston MA, USA, sshin@partners.org.
authors.forename: Sonya
authors.initials: S
authors.lastname: Shin
authors.forename: Maribel
authors.initials: M
authors.lastname: Muñoz
authors.forename: Adolfo
authors.initials: A
authors.lastname: Caldas
authors.lastname: Ying Wu
authors.forename: Jhon
authors.initials: J
authors.lastname: Zeladita
authors.forename: Milagros
authors.initials: M
authors.lastname: Wong
authors.forename: Betty
authors.initials: B
authors.lastname: Espiritu
authors.forename: Eduardo
authors.initials: E
authors.lastname: Sanchez
authors.forename: Miriam
authors.initials: M
authors.lastname: Callacna
authors.forename: Christian
authors.initials: C
authors.lastname: Rojas
authors.forename: Jorge
authors.initials: J
authors.lastname: Arevalo
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Sebastian
authors.forename: Jaime
authors.initials: J
authors.lastname: Bayona
mesh_terms: D015658:HIV Infections / Q000523:psychology; D006801:Humans; D008603:Mental Health; D010568:Peru; D036301:Qualitative Research; D057545:Social Stigma; D012944:Social Support